{"id":5519,"date":"2016-10-18T11:49:16","date_gmt":"2016-10-18T17:49:16","guid":{"rendered":"http:\/\/admin.patheos.com\/blogs\/janetheactuary\/?p=5519"},"modified":"2016-10-18T11:49:16","modified_gmt":"2016-10-18T17:49:16","slug":"narrow-networks-for-thee-not-for-me","status":"publish","type":"post","link":"https:\/\/www.patheos.com\/blogs\/janetheactuary\/2016\/10\/narrow-networks-for-thee-not-for-me.html","title":{"rendered":"Narrow networks for thee, not for me!"},"content":{"rendered":"\n<\/head>

In principle, I think narrow networks in health insurance plans are a good idea \u2014 if<\/strong><\/em> that means that doctors within the network coordinate care with each other and truly manage the patient\u2019s care, in the manner of the original HMOs, in which, after all, the entire concept was \u201chealth maintenance,\u201d and reducing the overall healthcare cost by working with the patient to stay healthy, manage diseases appropriately, etc. \u00a0In fact, if it were up to me, I\u2019d have Medicare move entirely to an \u201cHMO\u201d concept in which primary care physicians (or physician\u2019s assistants or nurse practitioners) exercise genuine coordination of care regarding the multiple specialists and dozen-odd drugs seniors are likely to take, since, let\u2019s face it, as you age you\u2019re less and less able to manage your healthcare in a \u201cmindful consumer\u201d sort of way.<\/p>\n

In practice, so far as I understand, anyway, the way the \u201cnarrow network\u201d plans are working is simply by including only those providers willing to accept lower levels of reimbursement.<\/p>\n

And, given our family\u2019s admittedly minor-in-the-grand-scheme-of-things brushes with high-cost healthcare (here<\/a> and here<\/a>, plus others not chronicled), that\u2019s why, when a plan appeared among the open enrollment choices this year with a substantially smaller premium than the rest but with my usual OB\/GYN provider not listed as in-network, I started digging. \u00a0\u201cSurely this is a mistake,\u201d I thought, as I\u2019ve never (not since our HMO days, long ago) seen them missing from the lists of providers, and I made some phone calls, eventually ending up on the phone with the insurer, who said, \u201cusually this provider is covered, but your employer is offering a narrower network plan.\u201d<\/p>\n

Now, I\u2019m as much a bargain-hunter as the next one, but I simply don\u2019t want to be in the situation of being at the hospital getting emergency care for myself or someone in the family, and worrying about whether the doctor on staff is in the network or not. \u00a0In fact, if it were just about the OB\/GYN practice, I\u2019d switch \u2014 I don\u2019t really care for infrequent check-ups. \u00a0But I\u2019m more concerned about what this suggests about their network, in general.<\/p>\n

In fact, that\u2019s one crucial piece of information that\u2019s missing, in the way our employer, and likely yours, too, provides health insurance plan information. \u00a0Sure, you can check if any particular doctor is listed. \u00a0But I\u2019d rather see a metric: \u00a0\u201cpercent of doctors within 10 mile radius of selected zip code who are in the plan\u2019s network.\u201d \u00a0Oh, and \u201cpercent of brand name medications which are included in the plan\u2019s formulary\u201d wouldn\u2019t hurt, either.<\/p>\n

So how\u2019s your annual enrollment going?<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"

In principle, I think narrow networks in health insurance plans are a good idea \u2014 if that means that doctors within the network coordinate care with each other and truly manage the patient\u2019s care, in the manner of the original HMOs, in which, after all, the entire concept was \u201chealth maintenance,\u201d and reducing the overall […]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[194],"class_list":["post-5519","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-employer-healthcare"],"yoast_head":"\nNarrow networks for thee, not for me!<\/title>\n<meta name=\"description\" content=\"In principle, I think narrow networks in health insurance plans are a good idea -- if that means that doctors within the network coordinate care with each\" \/>\n<meta name=\"robots\" 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